SITUATION REPORT FOR ACUTE WATERY DIARRHEA/CHOLERA

EPIDEMIOLOGICAL WEEK 4 (23RD 29TH JANUARY 2017)

Highlight of Cumulative data from
Highlights Epi-week 1-4, 2017

As of epidemiological week 4, the reported number of 877 new cases reported this week
AWD/Cholera cases has slightly decreased as compared to
the previous week but the outbreak has spread to new districts 15 deaths reported this week
in Puntland (refer table 1 below)
3 113 cumulative cases
A total of 877 new suspected AWD/cholera cases and 15
47 cumulative deaths
deaths (CFR: 1.7%) were reported from 37 districts during
epidemiological week 4 (23rd -29th January). 1.5% case fatality rate
Almost 51% of all new cases were recorded in Baidao district, 49% of cases are females
and 12% were reported from 4 districts in Puntland.
39% of cases are children under 5 years of age
New districts and villages in Lower Shebelle and two regions in
Puntland have reported new cholera cases, and the 33 districts in south central regions
surveillance officers are planning to conduct field investigation
and collect specimens 4 new districts in Puntland regions

Situation update
A total of 877 suspected AWD/cholera cases and 15 deaths
(CFR: 1.7%) were recorded from 37 districts across six regions
during this reporting period. However, the trend of cholera
cases recorded this week has slightly decreased as compared Map of Somaliashowing location of
to the cases reported in previous week (Refer to below table 1). AWD/Cholera cases and alerts January 2017
Of these cases, 107 of were reported from 4 districts in
Puntland for the first time in five years.

Total cumulative cases of 3 113 with 47 deaths (CFR; 1.5%) were

recorded across the country in the first four weeks of 2017.
However, the trend of cholera cases and deaths recorded in the
first four weeks is significantly higher as compared to the cases
recorded the same period in 2016 (refer to below epicurve N
graph). The current cholera outbreak is spill-over from last
years major cholera outbreak, which recorded 15,619 cases and
548 deaths. The current outbreak affected six regions in south
central and Puntland:

Bay Region: A total of 392 cholera cases and 11 deaths were

recorded in Baidao, Bayhow and Aliyow Munim districts as of week
4 and the trend has been increasing in the last four weeks.

Banadir Region: a total of 130 cholera cases 4 deaths were

recorded across 17 districts across the region and the number of
reported cases and deaths have decreases slightly in week 4. Legend
Hiiran Region: a total of 28 AWD/cholera cases and 0 deaths were Non Cholera alerts received

recorded in Beletweyn, Jalalaqsi and Buuloburte, and the trend of 0 100 200 km
Cholera hot spot, no active cases

cases and deaths declined in the last two weeks. active Cholera cases reported

Lower Shebelle Region: a total of 125 cholera cases and 0 deaths

were recorded in Marka, Shalanbod, Waagaade, Janaale and
Qoryoley districts, and the trend has decreased on week 4.

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 Middle Shebelle: a total of 95 cholera cases and 0 death were recorded in Jowhar, Mahaday, Balad and other villages,
and the outbreak has spread to new communities during this reporting period.
Bari: A total of 31 cases and no death were reported in in Bosasso district, and this is the first cholera is reported in
the last five years.
Mudug: A total of 76 cases and 0 deaths were recorded in Galdogob, Galkayo and Jariiban, and the most likely reason
is the water shortage due to the draught.

Considering the available surveillance data, even with the reduction in the number of cases reported this week
there is strong evidence that the cholera outbreak is spreading to new villages and districts, and the ongoing
draught and subsequent water shortage and malnutrition are exacerbating the spread of the outbreak.
Most of the districts reporting the cholera cases are along the Shebelle River and there is a severe water
shortage due to dryness of the river.
Active transmission of cholera is still going in all districts in Banadir region, but Hodan, Daynile, Dharkeynlay
and Wadajir recorded the highest number of cholera cases.

Table 1. Distribution and summary of AWD/Cholera cases and deaths

reported from Somalia (1-4 weeks), 2017
Region District Week 3 Week 4 Cumulative Cases
16th to 22nd January 2017 23rd to 29th January 2017 Week 1-4

Live Dead CFR Live Dead CFR Live Dead CFR

(%) (%) (%)
Banadir 17 districts 144 1 0.7 130 4 3.1 574 18 3.1
Bay Baioda 248 3 1.2 234 5 2.1 960 16 1.7
Aliyow Munim 121 1 0.8 47 2 4.3 168 3 1.8
Bayhow 94 0 0.0 111 4 3.6 315 4 1.3
Middle Jowhar 35 0 0.0 50 0 0.0 166 1 0.6
Shabelle
Mahadaay 8 0 0.0 11 0 0.0 49 1 2.0
Balad 34 1 2.9 20 0 0.0 54 1 1.9
Hawaadley 11 0 0.0 14 0 0.0 48 0 0.0
Hiraan Beletweyne 35 0 0.0 24 0 0.0 210 2 1.0
Buluborte 2 0 0.0 4 0 0.0 7 0 0.0
Jalaqsi 0 0 0.0 0 0 0.0 3 0 0.0
Lower Ajogoye 58 0 0.0 45 0 0.0 103 0 0.0
Shebelle
Janale 25 0 0.0 26 0 0.0 99 0 0.0
Busley 3 0 0.0 0 0 0.0 24 0 0.0
Waagaade 5 0 0.0 3 0 0.0 11 1 9.1
Qoryoley 0 0 0.0 9 0 0.0 9 0 0.0
Madulow 0 0 0.0 0 0 0.0 10 0 0.0
Marka hosp 9 0 0.0 10 0 0.0 32 0 0.0
Shalanbond 12 0 0.0 8 0 0.0 28 0 0.0
Hantiwadag 86 0 0.0 24 0 0.0 136 0 0.0
Mudug Galdogob 0 0 4.8 15 0 0.0 15 1 0.7
Galkayo 0 0 4.8 48 0 0.0 48 1 0.7
Jariiban 0 0 4.8 13 0 0.0 13 1 0.7
Mudug Galdogob 0 0 4.8 31 0 0.0 31 1 0.7

Total 930 6 0.6 877 15 1.7 3113 47 1.5

**CFR stands for case fatality rate, The most affected districts in Banadir include Afgoye (28), Baydhabo (23),
Boondheere(21), C/Casis (19) and Celesha (10)

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Fig 1. AWD/Cholera cases by Epi-week in Somalia; April 2016 - Jan 2017

2000 12.0

1800 Cases CFR (%)

10.0
1600
Number of AWD/Cholera cases

1400
8.0

Case Fatality Rate (%)

1200
Drought begins
1000 6.0

800
4.0
600

400
2.0
200

0 0.0

Week 1
Week 11

Week 3
Week 9

Week 17

Week 21

Week 51
Week 15

Week 31
Week 13

Week 41
Week 19

Week 27
Week 25

Week 37
Week 23

Week 29

Week 47
Week 35

Week 45
Week 33

Week 39

Week 43

Week 49
Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-16

weeks/months

Response activities

Coordination:
Multisectorial coordination mechanism at central and regional levels have been improved under the
umbrella of Health and WASH clusters;
Multi-sectorial response interventions have been implemented in most of the districts reporting
cholera cases including active case search, intensive household chlorination campaign, and
community awareness;

Surveillance and laboratory services:

Health partners operating in cholera affected districts have scaled up the response activities
including early warning surveillance, case management and WASH activities
Strengthened early warning surveillance especially at community level to ensure that case and
deaths at community level are identified and reported;
Zonal and regional surveillance officers have conducted field investigation to verify reported alerts
on suspected cholera cases and deaths in different locations
Active case search and referral of the cases were initiate in most of the affected communities

Patients care:
New CTCs to manage cholera cases were established in affected districts in Bay, Lower Shabelle ,
Bari and Mudug regions;
Refresher trainings were given to health workers managing the cases in different CTCs

WASH and Social mobilization:

In January, 17 WASH cluster partners responded through distribution of hygiene kits and
chlorination of shallow wells in Bay (Baidoa), Hiraan (Beletweyne, Jalalaqsi), Middle Shabelle
(Balad, Jowhar), Lower Juba (Dhobley, Badhadhe, Kismayo), Galgadud (Adado), Gedo (Belethawa,
Ceel waq), Banadir (Deynile, Banadir hospital), Lower Shabelle (Merka and qoryole) reaching
18,071HH

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 Logistics and supplies:
FMOH and WHO have delivered the following Emergency supplies to Muslim Aid for Wanla-weyn
district outbreak, 600 litres of Ringer Lactate , 2 cartons of ORS , 2 boxes of Aqua Tab, and 1DDK
to Qadar Red crescent for Afgoi and Balad districts.
FMOH and UNICEF have dispatched one DDK to SWISS Kalmo for Janale, Shalambot, Marka and
Qoryoley districts AWD/Cholera response and one DDK to Ayuub NGO for Mushani, Marka,
Gaywarrow AWD/Cholera response.
Security concerns have remained a major impediment to the implementation of sustained and
comprehensive cholera investigation and response activities in some of the cholera affected
villages;

OCV
The planning for the Oral Cholera Vaccination campaigns targeting seven hotspot locations in three
regions continued this week;

Urgent Needs
Shortage of funds is hampering the implementation of response activities to contain the ongoing
cholera outbreak in Somalia, and its important to raise funds to sustain the cholera response

Additional medical and non-medical supplies to be prepositioned in high risk districts

Building local capacities among health workers and partners on managing cholera cases and related
areas

Engagement of the local health authorities in monitoring the response activities in all affected districts

The weekly situation report is prepared by WHO and the health cluster team. For any queries kindly contact
Mutaawe Lubogo mutaawea@who.int; Iliana Mouradi mouradil@who.int; Abdihamid Ibrahim
Abdihamid.Ibrahim@savethechildren.org

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